1. Field of the Invention
The present invention relates to a device and method to improve dental treatments in small animals, particularly in situations where periodontal disease has progressed to the advanced stages of periodontitis and when dental pulp is exposed by fracture or disease.
2. Background of the Invention
Periodontal disease is especially prevalent in small animals. Periodontal disease can range from a localized inflammation of the gingiva (gingivitis) to inflammation of the gingiva, alveolar bone, the periodontal ligament and tooth structure (periodontitis).
Generally, the protocol for treating periodontal disease focuses on cleaning the oral cavity, repairing the tissue, and stopping the progression of the disease. However, available treatment methods, which include scalping, polishing, curettage, dental extractions, root planing, gingivectomies, and in extreme cases, gingival flaps or grafts are inadequate when treating advanced periodontitis.
Root planing is often necessary to remove necrotic tissue from the roots of periodontally involved teeth. A currette or Orban file is applied to the root surface and withdrawn in overlapping strokes using sufficient pressure to scrape necrotic cementum and debris from the root and smooth its surface. However, it is difficult to remove the necrotic debris without affecting the surrounding soft tissue.
A gingivectomy is often performed to eliminate gingival sulcus, in an effort to facilitate plaque control and oral hygiene. A gingivectomy is required where pocket depths exceed 4 mm, the epithelial attachment is still above bone level, and resection can be contained within the attached gingiva. The level of epithelial attachment is determined by using a periodontal probe and is marked on the buccal surface of the gingiva. The gingival tissue is then excised using a periodontal knife. Digital pressure is usually sufficient to effect hemostasis. However, it is difficult to limit resection to the attached gingiva. Additionally, the working space is limited in smaller breeds restricting maneuverability of instruments within the mouth thereby reducing the precision by which the procedure can be performed.
Cats exhibit particular manifestations of periodontal disease that are unique to the feline species. For example, a chronic problem in cats that is commonly associated with both chronic gingivitis/periodontitis and feline lymphocytic-plasmacytic stomatitis is external root resorption. Inflammatory resorption occurs at the cementoenamel junction. The presence of exuberant gingival tissue often conceals extensive cavitations in the tooth that undermine the crown eventually causing it to fracture and crumble thereby exposing the dentin. Exposed dentin is sensitive and extremely painful.
Typically, a fluoride gel is administered to treat this condition to desensitize the dentin. However, restoration has not been very successful and in many circumstances all of the teeth must be extracted. Extraction of involved teeth is often difficult because the crowns are weakened and therefore tend to fracture easily. Additionally, the roots are usually ankylosed and hard to separate from the surrounding bone. The long-term therapeutic response for treating external root resorption has typically been poor.
The cats are also placed on systemic antibiotics and long-term corticosteroids to reduce the risk of infection and to reduce inflammation. However, antibiotic treatments are usually not effective in treating feline lymphocytic-plasmacytic gingivitis/stomatitis because a primary bacterial causative agent has not yet been identified.
Tooth fracture is especially prevalent in canines. Cats tend to be more fastidious in their diet and occlusal habits, therefore, fractures of teeth are less common in cats than in dogs. A root canal is the conventional treatment method for tooth fractures. When the dental pulp is exposed by fracture or other disease, pulp contamination and necrosis will result in eventual resorption of supporting bone around the root apex as well as periapical abscessation or cyst formation. This process will result in eventual tooth loss. Endodontic therapy (root canal procedure) can be performed in order to ensure retention of an endodontically involved tooth. Endodontic treatment involves using a endodontic file to file away part of the contents or wall of the pulp canal. The enlarged canal is then sterilized with alternating flushes of hypochlorite (bleach) and hydrogen peroxide solutions and flushed with a sterile saline. The sterile canal is then dried and filled with root canal cement and one or more gutta percha points compressed in place. However, if the tooth is not sealed perfectly, bacteria present at the time of the procedure, can lead to pulpal necrosis and abscess formation.
Thus there is a need for a device and method that will improve dental treatment for small animals with periodontal disease and pulp exposure without the complications associated with the prior art.